Wang Hongwei, Wang Linlin, Li Zhong, Zhang Jiahang, Liu Guohui
Department of General Surgery, the Fourth Affiliated Hospital of Harbin Medical University, Harbin, China.
Department of Neurology, Heilongjiang Hospital, Beijing Children's Hospital, Harbin, China.
J Gastrointest Oncol. 2025 Jun 30;16(3):1038-1049. doi: 10.21037/jgo-2024-910. Epub 2025 Jun 16.
BACKGROUND: The current tumor node metastasis (TNM) staging manual of the American Joint Committee on Cancer (AJCC) could not satisfactorily classify colorectal cancer (CRC) patients with lymph node examined (LNE) <12. This study aims to construct a novel staging system for better predicting cancer-specific survival (CSS) in this special population. METHODS: Medical records of 4,170 CRC patients were retrospectively reviewed, including 3,927 cases from the Surveillance, Epidemiology, and End Results (SEER) database (development set) and 243 cases from The Second Affiliated Hospital of Harbin Medical University (validation set). Survival analysis was performed using Cox regression model. The best cutoff point of log odds of positive lymph nodes (LODDS) of CSS was calculated through the X-tile software. The performance of novel stage (nStage) was appraised by concordance index (C-index), receiver operating characteristic (ROC) curves and decision curve analyses (DCA). RESULTS: LODDS was an independent prognosticator for CSS and a novel N stage (nN stage) was built subsequently (nN0: LODDS ≤-1.1, nN1: -1.1< LODDS ≤-0.2 or cancer nodule formation and nN2: LODDS >-0.2). The C-indexes in the nStage system were higher and the 5-year ROC curves and DCA showed the superior power of the model compared with the AJCC system. Besides, in nStage C-E but not A-B CRC, patients who were treated with adjuvant chemotherapy posed a better prognosis. CONCLUSIONS: The nStage system demonstrated superiority over the AJCC staging system for CRC patients with LNE <12. And the proposed nStage system might provide clinicians with a potential reference for selecting patients who might benefit from adjuvant chemotherapy.
背景:美国癌症联合委员会(AJCC)当前的肿瘤淋巴结转移(TNM)分期手册无法令人满意地对检查淋巴结数(LNE)<12的结直肠癌(CRC)患者进行分类。本研究旨在构建一种新的分期系统,以更好地预测这一特殊人群的癌症特异性生存(CSS)。 方法:回顾性分析4170例CRC患者的病历,其中3927例来自监测、流行病学和最终结果(SEER)数据库(开发集),243例来自哈尔滨医科大学附属第二医院(验证集)。采用Cox回归模型进行生存分析。通过X-tile软件计算CSS的阳性淋巴结对数优势比(LODDS)的最佳截断点。通过一致性指数(C-index)、受试者工作特征(ROC)曲线和决策曲线分析(DCA)评估新分期(nStage)的性能。 结果:LODDS是CSS的独立预后因素,随后构建了新的N分期(nN分期)(nN0:LODDS≤-1.1,nN1:-1.1<LODDS≤-0.2或有癌结节形成,nN2:LODDS>-0.2)。与AJCC系统相比,nStage系统的C-index更高,5年ROC曲线和DCA显示该模型具有更强的预测能力。此外,在nStage C-E期而非A-B期的CRC患者中,接受辅助化疗的患者预后更好。 结论:对于LNE<12的CRC患者,nStage系统显示出优于AJCC分期系统的优势。所提出的nStage系统可能为临床医生选择可能从辅助化疗中获益的患者提供潜在参考。
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